Monday, April 4, 2016

The Need for Higher Standards in Correctional Healthcare to Improve Public Health

Over the last 40 years, the United States has experienced an
“epidemic” of incarceration, in which millions of Americans have spent days to years
of their lives in jails or prisons. During this time, correctional medicine has
undergone major changes.1,2In 1976, the
U.S. Supreme Court affirmed that failure to provide basic medical care to a prisoner
violates the Eighth Amendment to the Constitution banning cruel and unusual punishment.3Over the ensuing
decades, additional litigation or threat of litigation has forced correctional institutions
to provide a minimum community standard of healthcare to prisoners. In response,
accreditation bodies such as the National Commission on Correctional Health Care
have codified these minimum standards for prison and jail-based health systems to
follow through voluntary accreditation. However, a minority of the 4,575 correctional
institutions across the U.S. have volunteered to become accredited using these standards.
As a result, litigation remains the mainstay of enforcing correctional healthcare
standards,4and
correctional healthcare improvements have transpired piecemeal, typically with a
focus only on reaching the minimum standards that have been established.

While meeting minimum standards is critical in protecting
against Eighth Amendment violations, we argue thathigherstandards in correctional healthcare are capable
of improving individual and public health while controlling overall costs. With
2.2 million Americans behind bars, and 10 million cycling through correctional systems
each year,5U.S. correctional
healthcare has provided medical care to 1 in 30 living American adults, the majority
of whom are from impoverished communities, where poor healthcare access is the norm.6–10Since more
than 95% of prisoners eventually return to the community, correctional healthcare
has the opportunity, and the obligation, to transform care for persons and communities
most in need.11Moreover,
given that incarcerated populations are disproportionately from traditionally underserved
and/or disadvantaged backgrounds and have a high burden of disease, these goals
also hold the promise of reducing health disparities.6,8,12

We delineate three areas—screening and treatment for
hepatitis C, improved mental health care, including treatment for addiction disorders,
and attention to geriatric care—that exemplify the critical need for proactive,
evidence-based correctional healthcare that reaches beyond minimum standards and
integrates prisoner healthcare into mainstream medicine in order to improve the
health of individuals and communities.

Below: Number of U.S. Prisoners, 1925–2012

Below: Prevalence of Substance Abuse among State and Federal Prisoners

Below: Prevalence of Any Mental Illness among State and Federal Prisoners and Jail Inmates

Below: Prevalence of Hepatitis C in State and Federal Prisoners and Jail Inmates